Provider Demographics
NPI:1174270680
Name:TONGRET, TAMMRA R
Entity Type:Individual
Prefix:
First Name:TAMMRA
Middle Name:R
Last Name:TONGRET
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 5TH ST NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44703-2825
Mailing Address - Country:US
Mailing Address - Phone:330-775-4255
Mailing Address - Fax:
Practice Address - Street 1:1202 5TH ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44703-2825
Practice Address - Country:US
Practice Address - Phone:234-300-1923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-04
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH379255582699251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health